CAJ | 학술논문

目的总结血液病合并侵袭性肺部真菌感染的外科治疗经验.方法 2000年1月至2012年12月,共收治血液病合并侵袭性肺部真菌感染的病患78例,其中男49例,女29例,平均29.6岁.所有患者术前全部接受过相应方案化疗,疗程1～3次不等,平均抗真菌治疗时间4周.58例患者选择常规开胸手术,其中实施肺段切除者2例,肺叶切除者39例,单纯病灶楔形切除者17例;20例患者选择微创胸腔镜手术,其中全腔镜或腔镜辅助下肺叶切除者15例,单纯病灶楔形切除者5例.结果所有患者皆顺利完成手术,平均手术时间(125.3 ±35.7) min、术中失血(253.1±42.8)ml.术后无严重并发症,渗血超过1 000 ml者8例,持续漏气大于7天者6例.外科住院时间(7.8±2.5)天,无术后30天再手术及死亡病例.随访6～ 24个月,术后预防性抗真菌治疗者38例,无真菌扩散或复发者.结论血液病并发肺部真菌感染的患者,在内科保守治疗无效时,选择积极的外科手术治疗是安全且有益的.
목적 총결혈액병합병침습성폐부진균감염적외과치료경험.방법 2000년1월지2012년12월,공수치혈액병합병침습성폐부진균감염적병환78례,기중남49례,녀29례,평균29.6세.소유환자술전전부접수과상응방안화료,료정1～3차불등,평균항진균치료시간4주.58례환자선택상규개흉수술,기중실시폐단절제자2례,폐협절제자39례,단순병조설형절제자17례;20례환자선택미창흉강경수술,기중전강경혹강경보조하폐협절제자15례,단순병조설형절제자5례.결과 소유환자개순리완성수술,평균수술시간(125.3 ±35.7) min、술중실혈(253.1±42.8)ml.술후무엄중병발증,삼혈초과1 000 ml자8례,지속루기대우7천자6례.외과주원시간(7.8±2.5)천,무술후30천재수술급사망병례.수방6～ 24개월,술후예방성항진균치료자38례,무진균확산혹복발자.결론 혈액병병발폐부진균감염적환자,재내과보수치료무효시,선택적겁적외과수술치료시안전차유익적.
Objective To summarise the experience of surgical treatment of invasive pulmonary fungal infection in patients with hematologic malignancies.Methods From Jan.2000 to Dec.2012,78 hematologic patients with invasive pulmonary fungal infections,including 49 males and 29 females with average age of 29.6 years,underwent surgical treatment.Preoperatively,all patients with 1 to 3 courses of chemotherapy had received average 4 weeks antifungal treatment.There were 58 cases received conventional open thoracic surgery and 20 cases received VATS including lobectomy,segmentectomy,wedgectomy.Results The procedures were successful,the average operation time w as(125.3 ± 35.7) min and intraoperative blood loss was(253.1 ± 42.8) nl.There were no severe postoperative complications.The main complications were excessive effusion (10.2％) and persistence airleak (7.7％).The hospital days was(7.8 ± 2.5) days,no reoperation and death case in 30 days after operation.The follow-up was from 6 to 24 months,38 cases(48.7％) received prophylaetic antifungal treatment,no ease with fungi spread and recurrence.Conclusion The surgical treatment is safe and useful for the hematologic patients with invasive pulmonary fungal infections,when internal medicine conservative treatment is invalid.